TY - JOUR
T1 - Clinical Characteristics and Outcomes Among Travelers With Severe Dengue
T2 - A GeoSentinel Analysis
AU - Huits, Ralph
AU - Angelo, Kristina M.
AU - Amatya, Bhawana
AU - Barkati, Sapha
AU - Barnett, Elizabeth D.
AU - Bottieau, Emmanuel
AU - Emetulu, Hannah
AU - Epelboin, Loïc
AU - Eperon, Gilles
AU - Medebb, Line
AU - Gobbi, Federico
AU - Grobusch, Martin P.
AU - Itani, Oula
AU - Jordan, Sabine
AU - Kelly, Paul
AU - Leder, Karin
AU - Díaz-Menéndez, Marta
AU - Okumura, Nobumasa
AU - Rizwan, Aisha
AU - Rothe, Camilla
AU - Saio, Mauro
AU - Waggoner, Jesse
AU - Yoshimura, Yukihiro
AU - Libman, Michael
AU - Hamer, Davidson H.
AU - Schwartz, Eli
N1 - Funding Information:
Financial Support: This project was funded through a Cooperative Agreement between the Centers for Disease Control and Prevention and the International Society of Travel Medicine (Federal Award Number: 1 U01CK000632-01-00). Public Health Agency of Canada also provides a grant to the International Society of Travel Medicine. The analysis was cofunded by the GeoSentinel Foundation.
Funding Information:
The authors thank Christophe Burm at the Institute of Tropical Medicine, Antwerp, Belgium, for his valuable contributions to managing the electronic data collection. This project was funded through a Cooperative Agreement between the Centers for Disease Control and Prevention and the International Society of Travel Medicine (Federal Award Number: 1 U01CK000632-01-00). Public Health Agency of Canada also provides a grant to the International Society of Travel Medicine. The analysis was cofunded by the GeoSentinel Foundation.
Publisher Copyright:
© 2023 American College of Physicians. All rights reserved.
PY - 2023/8
Y1 - 2023/8
N2 - Background: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. Objective: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). Design: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. Setting: 20 of 71 international GeoSentinel sites. Patients: Returning travelers with complicated dengue. Measurements: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. Results: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 20 [23%]). Frequent reasons for travel were tourism (45%) and visiting friends and relatives (30%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgMþ/IgG_) and 12 as secondary (IgM_/IgGþ) dengue. Limitations: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. Conclusion: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.
AB - Background: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited. Objective: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue). Design: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022. Setting: 20 of 71 international GeoSentinel sites. Patients: Returning travelers with complicated dengue. Measurements: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue. Results: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 20 [23%]). Frequent reasons for travel were tourism (45%) and visiting friends and relatives (30%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgMþ/IgG_) and 12 as secondary (IgM_/IgGþ) dengue. Limitations: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited. Conclusion: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.
UR - https://www.scopus.com/pages/publications/85165222096
U2 - 10.7326/L23-0254
DO - 10.7326/L23-0254
M3 - Article
C2 - 37335991
SN - 0003-4819
VL - 176
SP - 940
EP - 948
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 8
ER -
SDG 3 Good Health and Well-being